Resorbable Fixation in Facial Plastic and Head and Neck Reconstructive Surgery: An Initial Report on Polylactic Acid Implants

• Published in: The Laryngoscope 2001-10, Vol.111 (10), p.1697-1701
• Main Authors: Moe, Kris S., Weisman, Robert A.
• Format: Article
• Language: English
• Subjects: Absorbable Implants; Adult; Aged; Aged, 80 and over; biodegradable plates; Biological and medical sciences; Bone Plates; Bone Screws; Facial Bones - injuries; Facial Bones - surgery; Facial bones, jaws, teeth, parodontium: diseases, semeiology; Female; Fracture Fixation, Internal; head and neck reconstruction; Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics; Humans; Male; Maxillofacial surgery. Dental surgery. Orthodontics; Medical sciences; Middle Aged; Non tumoral diseases; Otorhinolaryngology. Stomatology; Polyesters; Polylactic acid; Reoperation; resorbable fixation; Rhytidoplasty; Skull Fractures - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery, Plastic; Surgical Mesh
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1097/00005537-200110000-00005

Objectives The purpose of this study was to evaluate and report our initial experience with a resorbable fixation system in facial cosmetic and head and neck reconstructive surgery. The specific goals were to determine in which settings the absorbable system could be used, to evaluate the outcome of its use, to detail complications that occurred, and to report our observations on advantages and disadvantages of the system compared with traditional methods of osteosynthesis and fixation. Study Design A retrospective review of the initial 30 consecutive patients at the University of California, San Diego Division of Head and Neck Surgery who received polylactic acid (PLA) implants. Setting Academic tertiary referral/level I trauma center. Methods Criteria for inclusion into the study were any patient over age 18 who underwent a procedure involving the use of a PLA implant between March 1999 and October 2000. In addition to the typical indications for metal plate or mesh implantation, PLA was used for “protected bone regeneration.” Detailed records were kept of all patients in whom PLA implants were used, including the exact procedure and type of implant. All patients were operated by the authors. Operative reports, hospital charts, and office records were analyzed for any perioperative or postoperative complications. The attending surgeon noted advantages and disadvantages of the system. Patients have been followed from 2 to 18 months at the time of this report and are part of an ongoing long‐term follow‐up study. Results PLA implants were used in 35 procedures on 30 consecutive patients (multiple unilateral fracture repairs were counted as a single procedure). Uses included fixation of craniofacial fractures (zygomaticomaxillary, orbit floor, frontal bone [N = 9]; fixation of craniofacial osteotomy [N = 8]; protected bone regeneration [N = 3]; mandible, cranial bone donor site [N = 2]; bone grafting [N = 2]; craniectomy reconstruction [N = 2], and soft tissue suspension [endoscopic browlifting, N = 6, static facial suspension, N = 1]). There were 4 complications in this series: 2 partial flap losses, 1 in a patient who had had preoperative radiation and the other in a heavy smoker; 1 infected cranial bone flap in a patient who had had two prior surgeries and radiation; and 1 wound dehiscence over a plate that was improperly contoured. Advantages noted by the surgeons were ease of contouring the mesh or plates, including in situ reshaping, apparent decrease